EX-4.1



 Exhibit 4.1 
  






 
 ZQ|CERT#|COY|CLS|RGSTRY|ACCT#|TRANSTYPE|RUN#|TRANS# 
COMMON STOCK 
PAR VALUE $0.001 
Certificate Number 
ZQ00000000 
Imprivata 
COMMON STOCK 
THIS CERTIFICATE IS TRANSFERABLE IN CANTON, MA, JERSEY CITY, NJ AND 
COLLEGE STATION, TX

Shares 
* * 000000 ****************** 
* * * 000000 ***************** 
**** 000000 **************** 
***** 000000 *************** 
****** 000000 ************** 
THIS CERTIFIES THAT 
is the owner of 
IMPRIVATA, INC. 
INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 
** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David
Sample 
**** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David 
Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** Mr. Alexander 
David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. 
Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander
David Sample **** Mr Alexander David Sample **** Mr. Alexander David Sample **** 
Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample 
**** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David 
Sample ****
Mr. Alexander David Sample **** Mr. Alexander David Sample ****Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander

David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample
**** Mr. 
Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** 
Mr. Alexander David Sample **** Mr. Alexander David Sample **** Mr. Alexander David Sample ****
Mr. Alexander David Sample **** Mr. Sample **** Mr. Sample 
MR. SAMPLE & MRS. SAMPLE & 
MR. SAMPLE & MRS. SAMPLE

**000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares*** 
*000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares**** 
000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****0 
00000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****00
0000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000

000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****0000 
00**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****00000 
0**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000
**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000*

*Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000** 
Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**Shares****000000**S 
***ZERO HUNDRED THOUSAND 
ZERO HUNDRED AND ZERO*** 
CUSIP 45323J 10 3 
SEE REVERSE FOR CERTAIN DEFINITIONS 
FULLY-PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK OF 
Imprivata, Inc. (hereinafter called
the “Company”), transferable on the books of the Company in person or by duly authorized attorney, upon surrender of this Certificate properly endorsed. This Certificate and the shares represented hereby, are issued and shall be held
subject to all of the provisions of the Certificate of Incorporation, as amended, and the By-Laws, as amended, of the Company (copies of which are on file with the Company and with the Transfer Agent), to all of which each holder, by acceptance
hereof, assents. This Certificate is not valid unless countersigned and registered by the Transfer Agent and Registrar. 
Witness the facsimile seal of the Company
and the facsimile signatures of its duly authorized officers. 
President and CEO

Secretary, VP and General Counsel 
IMPRIVATA, INC. 
SEAL 
2001

DELAWARE 
DATED DD-MMM-YYYY 
COUNTERSIGNED AND REGISTERED: 
COMPUTERSHARE TRUST COMPANY, N.A. 
TRANSFER AGENT AND REGISTRAR, 
By 
AUTHORIZED SIGNATURE 
1234567 
Imprivata 
PO BOX 43004, Providence, RI 02940-3004 
MR A SAMPLE 
DESIGNATION (IF ANY) 
ADD 1 
ADD 2 
ADD 3 
ADD 4 
CUSIP XXXXXX XX X 
Holder ID XXXXXXXXXX 
Insurance Value 1,000,000.00 
Number of Shares 123456 
DTC 12345678 123456789012345 
Certificate Numbers Num/No. Denom. Total 
1234567890/1234567890 1 1 1 
1234567890/1234567890 2 2 2 
1234567890/1234567890 3 3 3 
1234567890/1234567890 4 4 4 
1234567890/1234567890 5 5 5 
1234567890/1234567890 6 6 6 
Total Transaction 7 







  

IMPRIVATA, INC. 
 THE COMPANY WILL FURNISH WITHOUT CHARGE TO EACH
SHAREHOLDER WHO SO REQUESTS, A SUMMARY OF THE POWERS, DESIGNATIONS, PREFERENCES AND RELATIVE, PARTICIPATING, OPTIONAL OR OTHER SPECIAL RIGHTS OF EACH CLASS OF STOCK OF THE COMPANY AND THE QUALIFICATIONS, LIMITATIONS OR RESTRICTIONS OF SUCH
PREFERENCES AND RIGHTS, AND THE VARIATIONS IN RIGHTS, PREFERENCES AND LIMITATIONS DETERMINED FOR EACH SERIES, WHICH ARE FIXED BY THE CERTIFICATE OF INCORPORATION OF THE COMPANY, AS AMENDED, AND THE RESOLUTIONS OF THE BOARD OF DIRECTORS OF THE
COMPANY, AND THE AUTHORITY OF THE BOARD OF DIRECTORS TO DETERMINE VARIATIONS FOR FUTURE SERIES. SUCH REQUEST MAY BE MADE TO THE OFFICE OF THE SECRETARY OF THE COMPANY OR TO THE TRANSFER AGENT. THE BOARD OF DIRECTORS MAY REQUIRE THE OWNER OF A LOST
OR DESTROYED STOCK CERTIFICATE, OR HIS LEGAL REPRESENTATIVES, TO GIVE THE COMPANY A BOND TO INDEMNIFY IT AND ITS TRANSFER AGENTS AND REGISTRARS AGAINST ANY CLAIM THAT MAY BE MADE AGAINST THEM ON ACCOUNT OF THE ALLEGED LOSS OR DESTRUCTION OF ANY SUCH
CERTIFICATE. 
  

																	
	The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations:	 	
							
	TEN COM	 	 -   as tenants in common
	 	UNIF GIFT MIN ACT	 	-	 	  
	 	Custodian	 	  

		 		 		 		 	(Cust)	 		 	(Minor)


																	
	TEN ENT	 	 -   as tenants by the entireties
	 		 		 	under Uniform Gifts to Minors Act	 	  

		 		 		 		 		 		 	(State)	 	


																	
	JT TEN	 	 -   as joint tenants with right of survivorship and not as tenants in common
	 	 UNIF TRF MIN ACT
	 	-	 	  

(Cust)
	 	Custodian (until age                      )	 	


													
		 		 	  
	 	under Uniform Transfers to Minors Act	 	  

		 		 	    (Minor)    	 		 		 	(State)
	  
 Additional abbreviations may also be used though not in the
above list.


  

			
		  	PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE
	
For value received,                    
             hereby sell, assign and transfer unto  
	  	 

  
  

(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING POSTAL ZIP CODE, OF ASSIGNEE) 
  

 
  

 

			
	  
  
	  	  
 Shares


 of the common stock represented by the within Certificate, and do hereby irrevocably constitute and appoint 

			
	  
	  	Attorney

 to transfer the said stock on the books of the within-named Company with full power of substitution in the premises. 

 

					
	Dated:	 	                                      
                          20              
      	  	 Signature(s) Guaranteed:
Medallion Guarantee Stamp
 THE SIGNATURE(S) SHOULD BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (Banks, Stockbrokers, Savings and Loan
Associations and Credit Unions) WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM, PURSUANT TO S.E.C. RULE 17Ad-15.

		 		  
	Signature:	 	                                      
                                         
         	  
	  
 Signature:
	 	  

                          
                                         
                     
	  
		 	 Notice:     The signature to this assignment must correspond with the name as written upon the face of the
certificate, in every particular, without alteration or enlargement, or any change whatever.
	  
		 		  
		 		  
		 		  	 

  

			
	 




	  	The IRS requires that we report the cost basis of certain shares acquired after January 1, 2011. If your shares were covered by the legislation and you have sold or transferred the shares and requested a specific cost basis
calculation method, we have processed as requested. If you did not specify a cost basis calculation method, we have defaulted to the first in, first out (FIFO) method. Please visit our website or consult your tax advisor if you need additional
information about cost basis.
	  	  
 If you do not keep in contact with us or do not have any activity in
your account for the time periods specified by state law, your property could become subject to state unclaimed property laws and transferred to the appropriate state.